I’m TID for 65 years, on Medicare and am on a pump, so I “see” my endo or her NP every 90 days. I’ve been doing televisits with my endo or her NP since before Covid (she was on sick leave prior to Covid and to protect her health, started doing televisits upon returning to work). My last in-person visit with either an endo or an endo NP was over 3 years ago. It’s a 30 minute trip if I were to go to an in-person endo visit–totally manageable. Televisits are definitely convenient and Medicare accepts/covers them. It seems an in-person visit, perhaps once a year, might be feasible now that Covid has become less of an issue. There are very few endocrinologists in my immediate area and I prefer not to have to drive far in winter months as I live in the upper Midwest (oh, those persnickety seniors, huh?!). I’d appreciate your experience/thoughts/comments on the continued use of televisits vs in-person visits.
Edit: I upload data from my t-slim to tconnect and have labs drawn prior to all endo visits; this works very well. I like the televisits—very convenient and efficient, just wondering how others feel about not seeing their endo/NP in person now, especially if distance isn’t an issue.
I use a Tslim with Dexcom g6. I am 2 hours away from my CDE nurse practitioner. No endo. Have been doing phone and zoom visits for the last 3 years. Three televisits and one in person visit and labs per year. I upload my data to t.connect and she downloads it. Never any problems. We discuss things briefly over the phone, she sends renewed Rxs and sends them to my pharmacy and it saves me 6 hours per visit. I love it!
What about checking for early signs of neuropathy? Sensory and reflex testing? Blood pressure? Cardiac and respiratory exam? Peripheral circulation? Abdominal exam? Thyroid physical exam?
There’s more to medicine than can be done remotely. Especially if a person has diabetes.
I have not seen my endo in person in over 3 years. She is on another island and used to fly here once a month for visits. With Covid that immediately stopped. As far as I know she has no plans to start coming over here again. I am sort of glad I did get to see her in person originally and I got to meet her but telehealth visits work great. I prefer telehealth visits whenever possible, it saves me time and hassle. For certain doctors visits it can’t replace an actual exam, but so many doctors visits are just going over different things or ordering tests. An endo visit for me is one that can easily be done by telehealth, she gets my cgm reports, she orders my scripts, and orders the routine blood tests for the next visit, all things that don’t need an in person visit. She also always responds promptly through MyChart for any requests. And an added bonus, I don’t actually even have to be at home.
Yes, CDEs are much easier to get appointments with. Their input is often more down-to-earth, too. Both endos and CDEs are good to have on your team, oc course, if possible. I’ve had some very knowledgeable CDEs and have found they are far more accessible than the doctors.
I was diagnosed 41 years ago back when internal medicine (including endos) was incredibly more hands-on. Every visit to the endo meant lots of poking and prodding at my internal organs not just by my doc but my the med school students being trained.
My hypothyroidism was diagnosed at first by poking and prodding at my thyroid and then confirmed in a follow-up lab test.
Today almost everything is a lab test and if it’s not a lab test it’s a MRI or CAT scan.
I don’t mean to be a grumpy old guy. And I didn’t exactly enjoy all those med students prodding into my internal organs at each endo visit 41 years ago. But I kinda miss doctors visits that had at least some hands-on.
I only use a GP and only recently started seeing him in person. I have him do blood work every three months and he just checks my A1c, because he has told me that I know more about diabetes than he does. At the last visit I asked if he ever does physicals and all he did was make sure I have had a colonoscopy and mammogram. He never touched me.
I have full feeling in my feet, andwould ask him to examine them if I felt it was necessary. I see my cardiologist once a year and he gives me various tests.
I feel like an old fashioned physical is missing from my care. I have considered changing physicians, and if I used a pump I would.
I now choose to actually see my doctor in person, so that I can get all of my questions answered.
Marilyn
Type 1 dx 1959
Marilyn, I used a GP for years. When I went to an endo it was the best change ever. My care increased at eat 100%. Oh and she even suggested a good GP for co care. Today I use a pump love my CDE and I suspect she has improved my life.
A previous GP sent me to an Endo whom she really respected, because she didn’t like how low my A1c was. The endo looked at my readings, checked my feet and was extremely impressed with how I had been taking care of my diabetes. He said that there was no reason to see him again and told my GP that I was doing great and that there was nothing wrong with my A1c.
My care really couldn’t be any better. 4.5 A1c, mostly flatlined between 65-120 and my best SD has been 14 and it is usually not much higher. I eat a low fat vegan whole plant based diet. 265 healthy carbs with 17-20 units of insulin daily. MDI and exercise.
I do have two heart stents which I received 12 yrs ago, because my LDL was too high on the Bernstein diet. Other than plaque which is getting better because of my diet, I don’t really have any other serious diabetic complications. If I ever decide to use a pump I will definitely seek the help of an endo or a diabetic educator.
My GP does some of the things on your list, but nobody does the stuff strictly related to diabetes. My first endo, years ago, used to check all those things, but since she retired, the next two only talk to me about my Dexcom and lab results. My pump educator nurse does all adjustments with basal and bolus. I never saw them in person during Covid, of course, but I see them in person now. They are mostly interested in my A1C and my eyes and kidney function. They get that info from lab tests.
There is something in between. I have an Endo when I’m in LosAngeles.
There aren’t so many Endos available in Seattle, so when I’m in Seattle I see an internal medicine GP.
Mine sees quite a number of diabetics, and most are in decent control. The out of control ones should see an Endo for sure to look into the reasons.
Most diabetics who can maintain an high TIR and a low A1c don’t need an Endo except when struggling.
I get good care from both doctors, however both doctors take my lead for the most part.
There is an “app” or program for the doctors use & the patient consents to have their pump data continuously shared with them. This is for T-Slim X2 pump.
